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Won Jin Lee,¹ Kay Teschke,² Timo Kauppinen,³ Aage Andersen,⁴ Paavo Jäppinen,⁵ Irena Szadkowska-Stanczyk,⁶ Neil Pearce,⁷ Bodil Persson,⁸ Alain Bergeret,⁹ Luiz Augusto Facchini,¹⁰ Reiko Kishi,¹¹ Danuta Kielkowski,¹² Bo Andreassen Rix,¹³ Paul Henneberger,¹⁴ Jordi Sunyer,¹⁵ Didier Colin,¹ Manolis Kogevinas,¹⁵ and Paolo Boffetta¹

¹International Agency for Research on Cancer, Lyon, France; ²University of British Columbia, Vancouver, Canada; ³Finnish Institute of Occupational Health, Helsinki, Finland; ⁴Norwegian Cancer Registry, Oslo, Norway; ⁵Stora Enso Oyj, Imatra, Finland; ⁶Nofer Institute of Occupational Medicine, Lodz, Poland; ⁷Massey University, Wellington, New Zealand; ⁸University Hospital Department of Occupational and Environmental Medicine, Linköping, Sweden; ⁹Claude Bernard University, Lyon, France; ¹⁰Federal University of Pelotas, Pelotas, Brazil; ¹¹Graduate School of Medicine, Hokkaido, Japan; ¹²National Centre for Occupational Health, Johannesburg, South Africa; ¹³Danish Cancer Society, Copenhagen, Denmark; ¹⁴National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA; ¹⁵Municipal Institute of Medical Research, Barcelona, Spain

Abstract

Our objective in this study was to evaluate the mortality of workers exposed to sulfur dioxide in the pulp and paper industry. The cohort included 57,613 workers employed for at least 1 year in the pulp and paper industry in 12 countries. We assessed exposure to SO₂ at the level of mill and department, using industrial hygiene measurement data and information from company questionnaires ; 40,704 workers were classified as exposed to SO₂. We conducted a standardized mortality ratio (SMR) analysis based on age-specific and calendar period-specific national mortality rates. We also conducted a Poisson regression analysis to determine the dose-response relations between SO₂ exposure and cancer mortality risks and to explore the effect of potential confounding factors. The SMR analysis showed a moderate deficit of all causes of death [SMR = 0.89 ; 95% confidence interval (CI) , 0.87-0.96] among exposed workers. Lung cancer mortality was marginally increased among exposed workers (SMR = 1.08 ; 95% CI, 0.98-1.18) . After adjustment for occupational coexposures, the lung cancer risk was increased compared with unexposed workers (rate ratio = 1.49 ; 95% CI, 1.14-1.96) . There was a suggestion of a positive relationship between weighted cumulative SO₂ exposure and lung cancer mortality (p-value of test for linear trend = 0.009 among all exposed workers ; p = 0.3 among workers with high exposure) . Neither duration of exposure nor time since first exposure was associated with lung cancer mortality. Mortality from non-Hodgkin lymphoma and from leukemia was increased among workers with high SO₂ exposure ; a dose-response relationship with cumulative SO₂ exposure was suggested for non-Hodgkin lymphoma. For the other causes of death, there was no evidence of increased mortality associated with exposure to SO₂. Although residual confounding may have occurred, our results suggest that occupational exposure to SO₂ in the pulp and paper industry may be associated with an increased risk of lung cancer. Key words: epidemiology, lung neoplasms, mortality, pulp and paper industry, sulfur dioxide. Environ Health Perspect 110:991-995 (2002) . [Online 15 August 2002]

http://ehpnet1.niehs.nih.gov/docs/2002/110p991-995lee/ abstract.html

Address correspondence to P. Boffetta, Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69008 Lyon, France. Telephone: 33-4-72738441. Fax: 33-4-72738320. E-mail: boffetta@iarc.fr

This study was partially supported by grant contracts from the European Commission's Biomed programme (BMH1-CT92-1110 and BMH4-CT95-1100) . W.J.L. worked on this study under the tenure of a Special Training Award from the International Agency for Research on Cancer.

Received 27 December 2001 ; accepted 5 March 2002.